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Momentum slows on shifting Medicaid

RALEIGH – Momentum slowed Wednesday for a proposal to shift control of North Carolina’s Medicaid program to an independent board of health experts when a legislative committee delayed an expected vote to recommend it to the full General Assembly.

The legislature’s government watchdog oversight committee only discussed the measure, which had been signed off on by one of its subcommittees last week, and did not take action.

The delay came because several House Republicans on the joint House-Senate Program Evaluation Oversight Committee were replaced late last week by newly elected House Speaker Tim Moore, R-Cleveland. The new members needed more time to get up to speed on the bill, according to committee co-chairman Sen. Fletcher Hartsell, R-Cabarrus.

Hartsell said the bill will be discussed again by the committee in February, but it’s unclear whether there will be a vote. The measure can still be considered in 2015 by the full General Assembly even without the committee’s recommendation, but the lack of a formal OK may signal a lack of strong bicameral support.

The subcommittee’s recommendation sought to end a portion of a months-long stalemate over how Medicaid should be governed. The health program covers 1.8 million state residents and spends one-sixth of the state’s $21 billion annual budget.

The bill would take control away from the Department of Health and Human Services, which is under Gov. Pat McCrory’s supervision, and give it to an eight-member Health Benefits Authority. It could increase or decrease Medicaid services to ensure the budget provided by legislators is met.

Sen. Ralph Hise, R-Mitchell, one of the subcommittee members, said the authority would bring stability to the program after years of large shortfalls until recently.

“I’m sure (the bill) will be part of any of the larger Medicaid reform discussions we’ll have,” Hise said.

Wednesday’s discussion allowed at least one House member taking a larger role on the committee and the state Medicaid director to raise more concerns about the measure.

Rep. Nelson Dollar, R-Wake, urged caution on making such a change in control over Medicaid. Medicaid director Dr. Robin Cummings also said the move if approved “could very well derail Medicaid reform.” The House and Senate also are trying to figure out how to shift more of Medicaid’s financial risk to private providers and medical entities.

Those no longer serving on the committee include Reps. Julia Howard, R-Davie, the committee co-chairwoman, and Justin Burr, R-Stanly, a lieutenant of previous House Speaker Thom Tillis. Burr competed with Moore to become Tillis’ successor. Howard and Burr participated in last week’s subcommittee.

The speaker makes the final decisions on committee assignments for every two-year session. The House clerk’s office said it received notice of the membership changes by email late Jan. 15, hours after the subcommittee completed its work.